Microvolt T-wave alternans and electrophysiologic testing predict distinct arrhythmia substrates: implications for identifying patients at risk for sudden cardiac death

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Guy AmitOtto Costantini


Better risk stratification of patients receiving an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is needed. Although microvolt T-wave alternans (MTWA) and electrophysiologic study (EPS) are independent markers for SCD, the Alternans Before Cardioverter Defibrillator (ABCD) trial found the combination to be more predictive than either test alone. The purpose of this study was to test the hypothesis that EPS and MTWA measure different elements of the arrhythmogenic substrate and, therefore, predict distinct arrhythmia outcomes. The ABCD trial enrolled 566 patients with ischemic cardiomyopathy, left ventricular ejection fraction (LVEF) <or=0.40, and nonsustained ventricular tachycardia. All patients underwent both MTWA test and EPS. The performance of MTWA and EPS in predicting stable ventricular tachyarrhythmic events (S-VTEs) versus unstable ventricular tachyarrhythmic events (U-VTEs), defined as either polymorphic ventricular tachycardia or ventricular fibrillation, was analyzed using Kaplan-Meier event rates and the log rank test. MTWA and EPS were abnormal in 71% and 39% of patients, respectively. There were 28 S-VTEs and 10 U-VTEs. MTWA was predictive of U-VTEs (event rate...Continue Reading


Jan 27, 1994·The New England Journal of Medicine·David S RosenbaumRichard J Cohen
Mar 17, 1999·Circulation·J M PastoreDavid S Rosenbaum
Jan 11, 2000·Circulation Research·J M Pastore, David S Rosenbaum
Mar 22, 2002·The New England Journal of Medicine·Arthur J MossMulticenter Automatic Defibrillator Implantation Trial II Investigators
May 28, 2002·Journal of Cardiovascular Electrophysiology·Daniel M BloomfieldRichard J Cohen
Jan 18, 2006·Journal of the American College of Cardiology·Sanjiv M Narayan
Jan 18, 2006·Journal of the American College of Cardiology·Daniel M BloomfieldJohn M Fontaine


Apr 11, 2013·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·S C WijersM Meine
Oct 19, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Raja J SelvarajVijay S Chauhan
May 17, 2011·Cardiac Electrophysiology Clinics·Guy Salama, F G Akar
Apr 27, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Sandeep V Pandit
Oct 20, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Leonardo CalòErnesto Lioy
Sep 13, 2013·Pacing and Clinical Electrophysiology : PACE·Takeshi KashimuraTohru Minamino
Oct 23, 2012·Journal of the American College of Cardiology·Demosthenes G KatritsisA John Camm
Mar 31, 2015·Physical Review Letters·Enrique Alvarez-LacalleYohannes Shiferaw

Related Concepts

Electrophysiology (Science)
Stroke Volume
Ventricular Fibrillation
Viral Markers
Left Ventricular Function
Sudden Cardiac Arrest
Tachycardia, Ventricular
Benefit-Risk Assessment
His Bundle Electrogram
Kaplan-Meier Estimate

Related Feeds


Cardiomyopathy is a disease of the heart muscle, that can lead to muscular or electrical dysfunction of the heart. It is often an irreversible disease that is associated with a poor prognosis. There are different causes and classifications of cardiomyopathies. Here are the latest discoveries pertaining to this disease.


Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.